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Evidence basis for antimalarial policy change in Sierra Leone: five in vivo efficacy studies of chloroquine, sulphadoxine-pyrimethamine and amodiaquine.
Trop Med Int Health. 2005 Feb; 10(2):146-53.TM

Abstract

OBJECTIVES

To provide nationally relevant information on the antimalarial efficacy of chloroquine (CQ), sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) in Sierra Leone, with a view to updating antimalarial policy in the country.

METHODS

Between October 2002 and May 2003, standard WHO methodology for in vivo efficacy assessment was used in five sites to study the therapeutic response of 6-59 months old uncomplicated Plasmodium falciparum malaria cases treated with CQ (n = 247), SP (n = 353) or AQ (n = 434). Follow-up was of 28 days, with polymerase chain reaction genotyping to distinguish late recrudescences from re-infections.

RESULTS

Overall 85.3% of patients reached an analysable endpoint. CQ failure proportions were very high, ranging from 39.5% (95% CI: 25.0-55.6) in Kabala to 78.8% (65.3-88.9) in Kailahun. Early failures under CQ were frequent. SP efficacy was also disappointing, with failure from 23.2% (13.9-34.9) in Kabala to 46.1% (35.4-57.0) in Kailahun. AQ resistance was more moderate, ranging from 5.4% (1.8-12.1) in Makeni to 29.8% (20.3-40.8) in Kailahun, with almost no early failures. AQ also provided more rapid fever and parasite clearance.

CONCLUSION

In a consensus meeting organized by the Ministry of Health and Sanitation, and based on these findings, artesunate (AS) + AQ and artemether-lumefantrine (Coartemtrade mark) were identified as the only options to rapidly replace CQ. The choice fell on AS + AQ because of expected high efficacy, lower cost in a blister presentation, and the absence of safety data on artemether-lumefantrine in pregnancy. Donor support is required to support this policy change. Throughout Africa, as SP resistance increases, these two regimens are probably the only options available while newer combinations are developed. Efficacy studies should focus on testing AQ and AS + AQ.

Authors+Show Affiliations

Epicentre, 8 rue Saint-Sabin, 75011 Paris, France. francesco.checchi@lshtm.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Controlled Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15679557

Citation

Checchi, Francesco, et al. "Evidence Basis for Antimalarial Policy Change in Sierra Leone: Five in Vivo Efficacy Studies of Chloroquine, Sulphadoxine-pyrimethamine and Amodiaquine." Tropical Medicine & International Health : TM & IH, vol. 10, no. 2, 2005, pp. 146-53.
Checchi F, Roddy P, Kamara S, et al. Evidence basis for antimalarial policy change in Sierra Leone: five in vivo efficacy studies of chloroquine, sulphadoxine-pyrimethamine and amodiaquine. Trop Med Int Health. 2005;10(2):146-53.
Checchi, F., Roddy, P., Kamara, S., Williams, A., Morineau, G., Wurie, A. R., Hora, B., Lamotte, N. d., Baerwaldt, T., Heinzelmann, A., Danks, A., Pinoges, L., Oloo, A., Durand, R., Ranford-Cartwright, L., & Smet, M. (2005). Evidence basis for antimalarial policy change in Sierra Leone: five in vivo efficacy studies of chloroquine, sulphadoxine-pyrimethamine and amodiaquine. Tropical Medicine & International Health : TM & IH, 10(2), 146-53.
Checchi F, et al. Evidence Basis for Antimalarial Policy Change in Sierra Leone: Five in Vivo Efficacy Studies of Chloroquine, Sulphadoxine-pyrimethamine and Amodiaquine. Trop Med Int Health. 2005;10(2):146-53. PubMed PMID: 15679557.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evidence basis for antimalarial policy change in Sierra Leone: five in vivo efficacy studies of chloroquine, sulphadoxine-pyrimethamine and amodiaquine. AU - Checchi,Francesco, AU - Roddy,Paul, AU - Kamara,Sarian, AU - Williams,Arthur, AU - Morineau,Guy, AU - Wurie,Abdul Rahman, AU - Hora,Bona, AU - Lamotte,Nadine de, AU - Baerwaldt,Tim, AU - Heinzelmann,Annette, AU - Danks,Alison, AU - Pinoges,Loretxu, AU - Oloo,Aggrey, AU - Durand,Rémy, AU - Ranford-Cartwright,Lisa, AU - Smet,Martin, AU - ,, PY - 2005/2/1/pubmed PY - 2005/3/25/medline PY - 2005/2/1/entrez SP - 146 EP - 53 JF - Tropical medicine & international health : TM & IH JO - Trop Med Int Health VL - 10 IS - 2 N2 - OBJECTIVES: To provide nationally relevant information on the antimalarial efficacy of chloroquine (CQ), sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) in Sierra Leone, with a view to updating antimalarial policy in the country. METHODS: Between October 2002 and May 2003, standard WHO methodology for in vivo efficacy assessment was used in five sites to study the therapeutic response of 6-59 months old uncomplicated Plasmodium falciparum malaria cases treated with CQ (n = 247), SP (n = 353) or AQ (n = 434). Follow-up was of 28 days, with polymerase chain reaction genotyping to distinguish late recrudescences from re-infections. RESULTS: Overall 85.3% of patients reached an analysable endpoint. CQ failure proportions were very high, ranging from 39.5% (95% CI: 25.0-55.6) in Kabala to 78.8% (65.3-88.9) in Kailahun. Early failures under CQ were frequent. SP efficacy was also disappointing, with failure from 23.2% (13.9-34.9) in Kabala to 46.1% (35.4-57.0) in Kailahun. AQ resistance was more moderate, ranging from 5.4% (1.8-12.1) in Makeni to 29.8% (20.3-40.8) in Kailahun, with almost no early failures. AQ also provided more rapid fever and parasite clearance. CONCLUSION: In a consensus meeting organized by the Ministry of Health and Sanitation, and based on these findings, artesunate (AS) + AQ and artemether-lumefantrine (Coartemtrade mark) were identified as the only options to rapidly replace CQ. The choice fell on AS + AQ because of expected high efficacy, lower cost in a blister presentation, and the absence of safety data on artemether-lumefantrine in pregnancy. Donor support is required to support this policy change. Throughout Africa, as SP resistance increases, these two regimens are probably the only options available while newer combinations are developed. Efficacy studies should focus on testing AQ and AS + AQ. SN - 1360-2276 UR - https://www.unboundmedicine.com/medline/citation/15679557/Evidence_basis_for_antimalarial_policy_change_in_Sierra_Leone:_five_in_vivo_efficacy_studies_of_chloroquine_sulphadoxine_pyrimethamine_and_amodiaquine_ L2 - https://doi.org/10.1111/j.1365-3156.2004.01367.x DB - PRIME DP - Unbound Medicine ER -